[PREDICTING PARAMETERS WITH FOCUS ON PRESSURE ULCERS IN IDENTIFYING ADVANCED DEMENTIA MORTALITY]

Longer life expectancy exposes the older person to vulnerability, morbidity and disability and increases the risk of developing dementia. The number of elderly patients with dementia reaching the advanced stage is increasing in entire settings. This condition of poor quality of life existing over months and years, when the time of death cannot be predicted, raises dilemmas in medical and ethical decisions. Dementia is an incurable disease at the last stage of life, highlighting a therapeutic approach in the provision of palliative care with emphasis on the quality of life as a primary goal. In older age, any advanced chronic disease is incurable and palliative care includes life-long therapies with hospice-type supportive care. Advanced dementia stresses an aggravated approach, and the recommendation is to provide only hospice type palliative care. The purpose of this survey is to review the existing evidence in base evidence literature containing prognostic parameters indicating mortality at six months including cognitive, functional, nutrition and morbidity factors, and focusing on pressure ulcers. Thus, the goal is to allow the attending team and the families to make appropriate evidence based medical-ethical decisions. A systematic review of the medical literature found seven articles with indices predicting mortality within six months in patients with advanced dementia (5 studies originated in the USA, 2 from Israel). The most common predictor variable in 100% of studies is eating and swallowing problems associated with the consequences of malnutrition and indigestion, weight loss and loss of appetite. The variable in 80% of the studies is background diseases including: cancer, heart failure, second-degree pressure ulcers, and lack of control of the sphincters. In 75% of cases, functional decline in personal care, level of consciousness and alertness are identified as variables, and in 60% of cases, mobility impairment unstable medical conditions and demographic conditions are diagnosed.